Health experts call for reforms to boost palliative care services

Health stakeholders have called for urgent reforms to strengthen the integration of sexual reproductive health (SRH) into palliative care services.

They cited policy gaps, cultural barriers, medication shortages, and inadequate funding as key obstacles affecting millions of Kenyans living with life-threatening illnesses.

The calls were made at a Mombasa hotel on Tuesday during a national workshop on SRH in palliative care convened by the Kenya Hospices and Palliative Care Association (KEHPCA).

Speaking at the forum, KEHPCA executive director David Musyoki emphasised that palliative care goes beyond end-of-life treatment, describing it as holistic support for patients and families from the point of diagnosis.

“Palliative care is holistic care for patients facing life-threatening conditions such as cancers, end-stage organ diseases, and cardiovascular illnesses. Sexual reproductive health is part of that holistic support,” he said.

Musyoki noted that adolescents and young adults diagnosed with cancer often face stigma and isolation at a time when they need emotional and social support the most.

He said palliative care providers play a critical role in addressing stigma, managing symptoms, and helping families cope throughout the illness journey.

Kenya launched the 2021–2030 National Palliative Care Policy to guide integration of services at all levels of healthcare, but stakeholders said implementation remained slow.

According to KEHPCA, only 124 health facilities currently provide palliative care services across the country, serving a population of nearly 50 million people.

Most of these facilities are located in major towns, leaving rural communities with limited or no access.

“There are patients at the grassroots level who need support. The question is: who is providing that care at the community level?” Musyoki posed.

He also highlighted a shortage of trained personnel, calling for palliative care training to be incorporated into undergraduate medical and nursing curricula to build a sustainable workforce.

Financing Gaps and Home-Based Care NeedsStakeholders welcomed the inclusion of palliative care under the Social Health Insurance framework but raised concerns that coverage remains limited, particularly for home-based care.

Many patients with chronic and advanced illnesses prefer receiving care at home rather than being admitted to hospital. However, home-based services are not fully covered, leaving families to shoulder heavy financial burdens.

“Diseases do not wait. Patients should not suffer economic hardship while seeking essential care,” Musyoki said.

From the grassroots level, Edwin Gitonga of Laikipia Hospice in Nanyuki said financial strain continued to affect both facilities and patients.

He noted that his facility provides free palliative care services to cancer patients but faces significant challenges, including shortages of critical pain-relief medication such as morphine.

“We are facing a huge crisis in accessing morphine. It should be free and consistently available,” he said.

He also appealed for government support in funding essential diagnostic tests such as Computed Tomography (CT) scans, Magnetic Resonance Imaging (MRI), and laboratory investigations, as well as basic supplies like colostomy bags and adult nappies, which many patients cannot afford.

Cancer, he added, is financially, physically, and psychologically draining, underscoring the need for palliative care from early stages of diagnosis.

Gynaecological oncologist Dr Anisa Mburu raised concerns about the limited attention given to sexual reproductive health among patients receiving palliative care.

She said discussions around intimacy, fertility, libido and sexual dysfunction remain taboo in many communities, particularly along the Coast region, leading to silent suffering and in some cases contributing to gender-based violence.

“In our cultural setup, we are embarrassed and shy to talk about these issues, yet both women and men are suffering,” he said.

Mburu revealed that a toolkit was being introduced to help healthcare providers create safe spaces for patients to openly discuss sexual health concerns.

She warned of a worrying trend of younger patients in their 20s, 30s, and 40s being diagnosed with non-communicable diseases and cancers, linking the rise to lifestyle changes, processed foods, smoking, alcohol consumption, and sexually transmitted infections such as human papillomavirus (HPV), a leading cause of cervical cancer.

Health experts also cited delayed diagnosis as a recurring problem, noting that patients were often treated repeatedly for common conditions such as gastritis before being correctly diagnosed with advanced cancers.

Dr Mburu urged both healthcare workers and the public to be more vigilant about persistent symptoms and to prioritise preventive measures, including healthy diets, regular exercise, and routine medical screenings.

Stakeholders concluded the workshop by urging the government to fast-track full implementation of the National Palliative Care Policy, expand training programmes, ensure a consistent supply of essential medicines, and strengthen public awareness campaigns.

They emphasised that integrating sexual reproductive health into palliative care is not optional but essential to preserving dignity, quality of life, and holistic well-being for patients and their families.